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APPLICATIC�`I FOR COLNSTRUCi �N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION ❑ COMBINATION � BUILDING ❑ M�CHANICAL LJ rUJM81NG ❑ SIGN <br />PAQ.iECTADCRESS: ��i/S' /"JsJdhDNA E�VE�ETJ c✓n 98to3 <br />�Ep MMLAOOf1ESS pIY zIP PIIpHE <br />/_ _ ../1 .� . <br />CIIY ZIP <br />7O 3LA- <br />VLUMBINCCONIR�CiCq M�ILADqiE55 /� CIiY DP PHONE SiQEUCENSE� <br />:�,/i iJM �� o. � O ?:/ <br />DESGFIBE Wp1N �ND SWMIE f00TA0E INVOIVED <br />' ?�xzv <br />II�CZD <br />/(Esic/i� ��.1 � <br />Fi10POSE0 USE OL BUILpNO <br />_ QLK oD0 D-ol Lor L <br />IEGALOESCRIPTION OF PROPE11tt^ 1.�_'MnN� BF.IZOW OR <br />IDT Z BIOGK _SCLL�.O`y� <br />CONSTHIICTIdILO/u1lEN0ER,ADURESSn.TELEPHONE <br />— ii <br />NO. I TYPE OF <br />UVATORY(WASHBAS <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DRINKING <br />FLOOR DF <br />PERMIT <br />FOR OFFICE USE ONLY: <br />f <br />E <br />HEATING SYS7'EM: �I GAS ❑ EIECTRIC ❑ <br />���r. rcnaynMvrnVryCrvV <br />���- /.,l�tCoc�� �� ' �1T�7�o <br />I HEREBY CERTIFY THAT I HAVE READ ANI) E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />EF JSnG PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPIII:D WITH WHETHER SPECIFIED HFREIN OR <br />rocociesl N07. THE ORANiIN(3 OF A PERMIT DOES NOT PRESUME TO 61VE <br />SP R E C Uh U A AUTHORITV TO VIDLATE OR CANCEL THE PqOVISION OF ,�pY <br />NOS � OTHEH STATE OR LOCAL LPW qEGULATIN6 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTAUCTION. THAT I AM AUTHORIZED BV THE <br />� o3�S C OWNER OF TfV1S PqOPE:�TV TO PERFORM THE WORK FOR WHICH <br />70 00 APPLICATION IS MADE AND I COMPLY WITH Tf1E SiATE <br />CONTRACTO�S LAW 18.27 RCW AND 296.200 WAC. <br />13er„q FtN ��qz � <br />x�—T y-3• 9G <br />SWnn�Of�t D�IE <br />3��JJ(p Q�Y6USINESSLICENSEN� <br />iRONTSETB�C,R��7- RE�RSEIBACK ' SIOESETB�LYS/J <br />(�</ / LCJ S <br />USEIONE n tUt�qEA yAC�N751fE <br />/ <br />❑YES ❑ NO <br />NEIGNTLIMIfA710N NO OFOWEIUNC SIZEOFBLDO/fl <br />%G4 � UNII$ _ _ _ <br />F� <br />On1E <br />NO.•^ TYPE OF EOUIPMENT <br />A/C—NHNDLO UNRS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DFiYERS <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURN <br />FIREPLACE INSEFif (WOOD BUR� <br />� GAS FIREPLACE <br />GASRANGE <br />PIAN CIIECN NUMBER <br />�UILOINC <br />AIECIInNIC�L <br />ES ❑ NO <br />RODIIION�L �UN C��F.CN <br />piNEf1 <br />SiA7E OUIIpMG SIIOCu4nGE <br />CITY OF EVERETT runucwonKs <br />LOCAL SALES <br />lAX CODE I$ 3105 TOTAL <br />fEf <br />SUB TOTAL S <br />PERMIT S <br />RECEIPT NO <br />FEE <br />